Comparison of procedure and predictability between WHO partogram and Paperless Partogram
Prof. Dr. Lalmohan Nayak, Dr Dillip Kumar Dalai, Dr Liza Bisi, Dr Rupam Sarkar
WHO partogram,is cumbersome and time consuming procedure for overburdened Indian labour room setup very few clinicians use it. To circumvent the above problem Debdas (2006) introduced a very simple almost timeless mental method called Paperless Partogram which is based on Friedmans rule.Objectives Assessment of procedural difference, predictability of time of delivery, user friendliness and fetal outcome between WHO and Paperless partogramMaterial: Any uncomplicated patient irrespective of age and parity in spontaneous onset labour with cephalic presentation who is at least 4cm dilated carrying pregnancy of 37 completed weekMethod: In paperless group, right at first PV the Expected TIME of delivery (ETD) was calculated by mentally adding to the time-point of PV - the number cm left to full dilatation using Friedmans formula of cervical dilatation of 1cm/hour. Birth attendant has to add 4 hours to the alert ETD to get Action ETD. Both the ETDs were written in the front of case sheet for everybodys attention. In WHO group PV was done 2 hourly and plotted on graph in usual way.Results: Around 75% of cases of both group were age ranged between 25-30 years, primipara and of gestation between 38-40 weeks. Vaginal delivery occurred in: WHO-87%, Paperless-89%. One minute Apgar: WHO-97%, Paperless-96% - highly comparable. Even the augmentation rate (74% in Paperless, 77% in WHO group) and NICU admission rate (1.4% in paperless, 1.62%) were also comparable.The only difference found was in user friendliness. While in Paperless group 100% became fan of the method, 96% of WHO group expressed that they would like to switch to paperless method, only 4% were not sure.Conclusion: Paperless Partogram is 1) equally effective and efficient as the WHO method as a labour management tool, 2) The great point about it is-it is highly user friendly and hence ideal for resource poor situations.
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